Group/ School membership application

This form may be completed by teacher, coordinator or supervisor for Science Project activities. Person identified in this form will be the only authorized contact for this new group membership account. 

   
 First Name   
 Middle Initial
 Last Name
 Street Address   (No P.O.Box please)
 Apt./ Unit
 City
 State (select or type)

Other:

 ZIP Code
 Country   (Select)
 School Name
 Date of Birth  Month: Day: Year:
 Position
 Gender Male Female
 Email Address  (We email you your member-id)
 Phone Number:        Fax Number
   
   

Please verify the above information and then click on the following button to submit your application.